Early and Late Patency of Aortocoronary Vein Grafts

Björk, Viking Olov; Ekeström, S; Henze, Axel; Ivert, Torbjörn; Landou, Christian

doi:10.3109/14017438109101020

Cited by 66 publications

(21 citation statements)

References 20 publications

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“…In addition to several patient- and graft-specific factors, PFA-100 CADP CT and UTXB 2 measured 6 months after CABG surgery correlated with early SVG occlusion by univariate analysis (Data Supplement Tables 2–5) when expressed both as continuous variables and as binary variables based on respective median (88 seconds) and upper quartile values (450 pg/mg creatinine). When analyzed either as continuous (Model 1) and binary (Model 2) variables in multivariate analyses (Table 4), PFA-100 CADP CT and UTXB 2 remained significantly associated with SVG outcome along with target vessel diameter ≤1.5 mm, historically recognized as one of the strongest risk factor for early SVG occlusion (16–18). SVG occlusion was also more prevalent in subjects with both CADP CT ≤88 seconds and UTXB 2 ≥450 pg/mg creatinine than in subjects with CADP CT >88 seconds and UTXB 2 <450 pg/mg creatinine (32% versus 10%, respectively, p <0.0001).…”

Section: Resultsmentioning

confidence: 99%

Effects of Aspirin Responsiveness and Platelet Reactivity on Early Vein Graft Thrombosis After Coronary Artery Bypass Graft Surgery

Gluckman¹,

McLean²,

Schulman³

et al. 2011

Journal of the American College of Cardiology

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Objectives To determine if an incomplete response to and/or inadequate antiplatelet effect of aspirin contribute to saphenous vein graft (SVG) occlusion after coronary artery bypass graft (CABG) surgery. Background Thrombosis is the predominant cause of early SVG occlusion. Aspirin, which inhibits cyclooxygenase-1 activity and thromboxane generation in platelets, reduces early SVG occlusion by half. Methods Aspirin-responsiveness and platelet reactivity were characterized 3 days and 6 months after CABG in 229 subjects on aspirin monotherapy by; platelet aggregation to arachidonic acid, ADP, collagen and epinephrine; PFA-100 closure time (CT) using collagen/epinephrine (CEPI) and collagen/ADP (CADP) agonist cartridges; VerifyNow Aspirin assay, and; urine levels of 11-dehydro-thromboxane B2 (UTXB2). SVG patency was determined 6 months after surgery by computed tomography coronary angiography. Results Inhibited arachidonic acid-induced platelet aggregation, indicative of aspirin-mediated cyclooxygenase-1 suppression, occurred in 95% and >99% of subjects 3 days and 6 months after surgery, respectively. Despite this, 73% and 31% of subjects at these times had elevated UTXB2. Among tested parameters, only UTXB2 and PFA-100 CADP CT measured 6 months after surgery correlated with outcome. By multivariate analysis, CADP CT ≤88 seconds (OR 2.85, P=0.006), target vessel diameter ≤1.5 mm (OR 2.38, P=0.01) and UTXB2 ≥450 pg/mg creatinine (OR 2.59, P=0.015) correlated with SVG occlusion. CADP CT and UTXB2 in combination further identified subjects at particularly high- and low-risk for SVG occlusion. Conclusions Aspirin-insensitive thromboxane generation measured by UTXB2 and shear-dependent platelet hyper-reactivity measured by PFA-100 CADP CT are novel independent risk factors for early SVG thrombosis after CABG surgery.

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Section: Resultsmentioning

confidence: 99%

Effects of Aspirin Responsiveness and Platelet Reactivity on Early Vein Graft Thrombosis After Coronary Artery Bypass Graft Surgery

Gluckman¹,

McLean²,

Schulman³

et al. 2011

Journal of the American College of Cardiology

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“…Despite this, CABG remains the standard treatment for patients with severe three-vessel CAD or affection of the left main stem [14]. Although CABG provides excellent patency-and recovery rates, early and late graft failure still limit the success of autologous graft transplantation for treatment of CAD [15]. Several factors, for example, methods of vessel preparation, hydrostatic distension of venous grafts, quality of target vessel, run-off, and the progress of the patient's CAD itself, were identified to affect the long-term outcome of CABG.…”

Section: Discussionmentioning

confidence: 97%

Even short-time storage in physiological saline solution impairs endothelial vascular function of saphenous vein grafts

Wilbring¹,

Tugtekin²,

Zatschler

et al. 2011

European Journal of Cardio-Thoracic Surgery

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“…However, this qualitative rating likely incorporates the elements of smaller vessel diameter that might reflect challenging surgical anatomy and poor distal run-off, which has been previously associated with VGF. 7 …”

Section: Discussionmentioning

confidence: 99%

Saphenous Vein Graft Failure After Coronary Artery Bypass Surgery

et al. 2014

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Background Coronary artery bypass grafting (CABG) success is limited by vein graft failure (VGF). Understanding factors associated with VGF may improve patient outcomes. Methods and Results We examined 1828 participants in the PREVENT IV trial undergoing protocol-mandated follow-up angiography 12–18 months post-CABG or earlier clinically-driven angiography. Outcomes included patient- and graft-level angiographic VGF (≥75% stenosis or occlusion). Variables were selected using Fast False Selection Rate methodology. We examined relationships between variables and VGF in patient- and graft-level models using logistic regression without and with generalized estimating equations. At 12–18 months post-CABG, 782 of 1828 (42.8%) patients had VGF, and 1096 of 4343 (25.2%) vein grafts had failed. Demographic and clinical characteristics were similar between patients with and without VGF, though VGF patients had longer surgical times, worse target artery quality, longer graft length, and more frequently underwent endoscopic vein harvesting. After multivariable adjustment, longer surgical duration (odds ratio [OR] per 10-minute increase 1.05, 95% confidence interval [CI] 1.03–1.07), endoscopic vein harvesting (OR 1.41, 95% CI 1.16–1.71), poor target artery quality (OR 1.43, 95% CI 1.11–1.84), and postoperative use of clopidogrel or ticlopidine (OR 1.35, 95% CI 1.07–1.69) were associated with patient-level VGF. The predicted likelihood of VGF in the graft-level model ranged from 12.1–63.6%. Conclusions VGF is common and associated with a number of patient and surgical factors. These findings may help identify patients with risk factors for VGF and inform the development of interventions to reduce VGF.

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Early and Late Patency of Aortocoronary Vein Grafts

Cited by 66 publications

References 20 publications

Effects of Aspirin Responsiveness and Platelet Reactivity on Early Vein Graft Thrombosis After Coronary Artery Bypass Graft Surgery

Effects of Aspirin Responsiveness and Platelet Reactivity on Early Vein Graft Thrombosis After Coronary Artery Bypass Graft Surgery

Even short-time storage in physiological saline solution impairs endothelial vascular function of saphenous vein grafts

Saphenous Vein Graft Failure After Coronary Artery Bypass Surgery

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